OBJECTIVES: Depression is common, affecting approximately 9.5% of American adults each year. Depression tends to be under-diagnosed and under-treated in the primary care setting. Due to numerous obstacles, primary care physicians fail to diagnose depression in up to 50% of cases. The tendency to prioritize medical problems in the primary care setting may lead to failure to detect depression in patients with unexplained somatic symptoms. Assessment tools may help providers identify cases of depression within the constraints of a typical office practice and can provide significant value for patients, providers, and managed care organizations. METHODS: The study was designed to assess the impact of electronic messaging on the identification and treatment of depression in patients with low back pain. Electronic-prescribers received a message after entering an ICD-9 code for low back pain. The message briefly describes the relationship between depression and pain, and offers the option to view a depression screener and a summary of treatment guidelines. Examining drugs prescribed for patients with low back pain assessed the intervention. Physician encounter data were assessed before and after messaging implementation. RESULTS: Physicians that received the electronic messages were more likely to identify depression in patients with low back pain. An increase in the proportion of patients with low back pain prescribed antidepressants may indicate that the electronic messages assisted physicians in the identification and treatment of depression in these patients. CONCLUSIONS: Electronic messaging at the point of care appears to be an effective method to offer information to physicians at the time the information is needed.